Delusions or self sabotage: International fellowship

Started by ccvvbj
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ccvvbj

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Please take the time to read, it's a lengthy post. To mods, please do not delete, I can always modify this post if against any rules.
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I'm seriously considering pursuing an international 'fellowship' after residency and wanted to get your perspectives on the pros, cons, and overall feasibility of this plan. Bonus points if you have done one in the past/ worked abroad doing foot and ankle surgery.

I'm a first year resident. From a training standpoint, I feel confident that I’ll graduate with strong proficiency in forefoot and midfoot surgery. However, podiatry's exposure to rearfoot and ankle cases is somewhat limited by the orthopedic department. Currently, we have 4 podiatrists who bring rearfoot cases. We also have 1 month (may extend to 3 months if I can convince the right people) orthopedic trauma rotation. Although I expect to be comfortable with core procedures like ankle fracture fixation (likely not pilons), ankle fusions, and Achilles tendon repairs, I don’t anticipate feeling fully confident managing the broader spectrum of complex rear foot and ankle reconstruction by the end of residency. This, along with a longstanding interest (since podiatry school) in working abroad, is my reason for pursuing this desire.

A fellowship in the States may come with similar restrictions as my current residency training, if not worse.

As I mentioned earlier, I’m particularly interested in an international fellowship (or a series of structured work/learning experiences abroad), both for the educational value and the experience itself. My tentative plan would be to spend 1–3 years rotating through regions like Europe, and the Middle East, gaining exposure to different surgical techniques, pathology, and healthcare systems. I’d likely return to the U.S. periodically for locum work to maintain income and clinical continuity.

My plan is to work for a couple of years, get my certifications, pay off loans prior to going abroad.

A few specific questions I’ve been trying to think through:

- Do you think pursuing an international fellowship is a smart move, or does it pose too much risk in terms of long-term job stability and career trajectory especially due to current job market?

- How 'easy' is it to obtain ABFAS RRA certification after residency? This is, especially, directed towards individuals in private practice. What were the challenges you faced?

- Is it realistic to negotiate flexibility like a fellowship or sabbatical into an employment contract early in my career? For example, structuring something like 6 months abroad then 6 months in the U.S., even if it comes with reduced compensation?

- What are your recommendations for a non formal international "fellowship" pathway? I’m very interested in how foot and ankle surgery is practiced globally, and I suspect international settings may offer stronger opportunities to build more skills in rearfoot and ankle surgery, foot pathology.

Regardless of the feedback I receive or the practical challenges involved, I’m committed to pursuing this goal. It’s something I believe I would regret not doing later in life, and I recognize that it may become much harder to pursue as I take on additional personal responsibilities. I’m seeking input primarily to better understand how to approach this thoughtfully and realistically while I still have the flexibility to do so.
 
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As I mentioned earlier, I’m particularly interested in an international fellowship (or a series of structured work/learning experiences abroad), both for the educational value and the experience itself. My tentative plan would be to spend 1–3 years rotating through regions like Europe, the Middle East, and West Africa, gaining exposure to different surgical techniques, pathology, and healthcare systems. I’d likely return to the U.S. periodically for locum work to maintain income and clinical continuity.

My plan is to work for a couple of years (likely less than 5 years), get my certifications, pay off loans (under $120k) prior to going abroad.

A few specific questions I’ve been trying to think through:

- Do you think pursuing an international fellowship is a smart move, or does it pose too much risk in terms of long-term job stability and career trajectory especially due to current job market?

- How 'easy' is it to obtain ABFAS RRA certification after residency? This is, especially, directed towards individuals in private practice. What were the challenges you faced?

- Is it realistic to negotiate flexibility like a fellowship or sabbatical into an employment contract early in my career? For example, structuring something like 6 months abroad then 6 months in the U.S., even if it comes with reduced compensation?

- What are your recommendations for a non formal international "fellowship" pathway? I’m very interested in how foot and ankle surgery is practiced globally, and I suspect international settings may offer stronger opportunities to build more skills in rearfoot and ankle surgery, foot pathology.

Regardless of the feedback I receive or the practical challenges involved, I’m committed to pursuing this goal. It’s something I believe I would regret not doing later in life, and I recognize that it may become much harder to pursue as I take on additional personal responsibilities. While I’m currently single with no children, I anticipate that I may be married, have children, and take on a caregiving role for my parents 7-10 yrs post residency. I’m seeking input primarily to better understand how to approach this thoughtfully and realistically while I still have the flexibility to do so.
Gonna be real with you- married with kids and this sounds like utter nonsense to me.

I do see the side of you wanting to live out your dreams while you're still single. If that means going out of the country to experience, go for it.

Network and see who's done what in what country.

Telling you right off the bat, there is no reason to hire you 6mo on 6mo off to work your "fellowship" into the contract.
I can't see that happening from a group or PP perspective.
When they hire, they want you in the office being productive.
The 6mo you are gone will mean having to cover for you half the year.
Doesn't make sense unless they are starting a new office and need an immediate hire for cheap to keep patients coming in the door and build.
Once you're up and running in 6mo, why should they keep you on for another 6mo when they could just hire another associate?

You will have to answer for the periods of unemployment on job applications.
Could probably get around that by putting further fellowship training- just make sure you have sources that are reachable when they run checks or send surveys that ask "Is ccvbj someone capable in OR etc etc".
That will be tricky with your globe trotting.

Building RRA case load from a PP point is tricky. In my case it would be very hard simply because the volume of trauma (easy bimals etc) isn't readily walking into a private office.
It is getting funneled from ERs internally to their own ortho or podiatry (rare).
If you're in a state that is ortho friendly- you probably aren't seeing much trauma come your way as the podiatry department.
If you're a PP office looking- even harder.
You can circumvent by finding pathology like flatfoot recons, ankle instabilities, meemaw with the coalesced STJ whatever to operate on- but again, harder simply from a pure volume standpoint.
Which also begs the question- are you signing that patient up for surgery because they need it? Or because you need it? There is pressure to operate whether we want to admit it or not.
You could also try getting friendly with the local ERs and taking unpaid call.
I refuse to.
Local pod near me said something that made me respect him- if we all collectively agree not to screw the next guy over by refusing to take unpaid call- the hospitals will start to at least perk up and it helps everyone.
Granted the guy will still do the ER docs a favor and book an amp or I&D inpatient- again he's PP so its a huge time sink and money loss for him- he just does it cause its the right thing to do.

I don't have any advice on setting up an international fellowship. There are a few people on here who have connections- Diabeticfootdoctor and Glasgow etc.

After residency I personally had zero desire to do a fellowship and knew what I wanted to do after graduating- which would not require additional fellowship training my residency didn't already provide.

Again- I think your plan is totally bogus if it was me- but I respect you for putting it out there and at least going through a feasibility plan if its what you want to do- no ragerts and all that.

Couple other random non-solicited thoughts:

Set up funding in advance. You have student loans (assuming).
Figure out that relative number will be to fund all of this + for how many years.
Figure out what your loans are gonna sit at while you do all of this in terms of repayment.

Second thing- be careful with where you are travelling.
Some countries are safer than others.
You don't have to go to the Middle East to learn how to put a frame on.
You don't have to go to West Africa to learn salvage procedures.
A foot is a foot. If you're going to end up practicing in the US, it doesn't matter if you've served a mission in Antarctica.

Third thing- Are you sure something like Peace Corps or Doctors Without Borders won't scratch your itch?
How relevant is the experience and "training" you get from those countries going to be when you come back and open up shop?
Are you really doing it for the training or just to check off an innate goal you've had?

Fourth thing- You are an intern.
There's a lot you know but there's also a lot you haven't experienced yet.
Before fully committing- even if your residency isn't the greatest- make sure you are milking it for what its worth before you jump ship.
 
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If you have connections or a way to do that then sure obviously it sounds like you're set on it. But you're paving your own path this is not like orthopedics where these fellowships and things exist. Good luck to you.

Everything you're trying to do in terms of practicing in the United States no that sounds ridiculous you don't need to do any of that.
 
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you also have to be prepared to not have any Locums opportunities (or at least very little flexibility in terms of the opportunities that do exist) when you want to come back to the US and make some money.

Locums in podiatry is not a “wherever, whenever you want” like it is for most MD/DOs. You can go months without a true hospital or MSG based gig that offers fair compensation as a podiatrist trying to do locums. You will have a lot more financial issues during this international training journey than you think. Certainly far more issues than a Physician would, strictly due to lack of locums opportunities.
 
Yeah I was trying to be nice. If you're independently wealthy congratulations. If you're counting on working while doing all of this to support yourself it's a terrible idea and is never going to work. Your a first year there's other things to focus on

You are a podiatrist. All these great skills that you think you're getting you get them by doing them not by watching other people do them The sooner you start creating something for yourself to be able to do those procedures the better. More training in podiatry is not the answer. Look at all these fellowship people going into private practice doing minimal surgery. You are overthinking this.

Also, and I'm genuinely curious about this... If you have a degree that is not recognizing their nationally.... You were just going to watch other people do surgery? That's called YouTube
 
what the hell did I read.

Focus on finishing your time here first.

You’re better off networking like your career depended on it to land a fair job after training. That’s where your time and energy should be spent.

Most fellowship trained pods assume they has a golden ticket lined up. Nope.
 
It would likely be beneficial for your education and skills if you can pull it off but not guaranteed to benefit you in future job opportunities. Who knows though, if you do fellowship with the right people, those connections could land you in a good spot. I think a lot of good podiatry positions have come about purely from having the right connections or knowing the right people.
 
Yeah I was trying to be nice. If you're independently wealthy congratulations. If you're counting on working while doing all of this to support yourself it's a terrible idea and is never going to work. Your a first year there's other things to focus on

You are a podiatrist. All these great skills that you think you're getting you get them by doing them not by watching other people do them The sooner you start creating something for yourself to be able to do those procedures the better. More training in podiatry is not the answer. Look at all these fellowship people going into private practice doing minimal surgery. You are overthinking this.

Also, and I'm genuinely curious about this... If you have a degree that is not recognizing their nationally.... You were just going to watch other people do surgery? That's called YouTube
First year resident with under 120k in loans
 
I had same similar thoughts when I was a student up until final year of residency. I was going to apply for the PAMF fellowships and then spend a year in Russia to do frames. My residency director learned about this (cuz I needed his LOR for fellowship applications), sat down with me, told me it's not worth it and no fellowship training beats real work experience in terms of job prospects.

I am so glad I took his advice. He's absolutely correct. Fellowships in other medical fields add to the scope of practice, allowing you to do more. Fellowships in podiatry don't achieve the same effect.
It doesn't matter if you are trained well. A patient coming to you for post-op ankle ORIFs will still ask you to trim their nails. It will never happen to Ortho.

Reimbursement for complex rearfoot reconstructions is only going down every year. You can't make it a sustainable part of the practice unless you bill fraudulently, or if you are RVU based working for hospitals to profit share the ancillary services and facility fees.

These cases also generate lots of demand for disability paperwork and narcotic refills. Patients will never be truly satisfied because the foot/ankle will always be stiff, they will always complain about subtle neuritis symptoms, and revisional work may still be needed.

Once I figured this out I cut it off from my practice completely. Now I just do podiatry. Injections, orthotics, debridements, forefoot recons, gastrocs and some ligament repairs, and that's about it. Stress is down but income is up.

Don't do it. The demand for complex rearfoot and ankle recon is just not there. IMO even much of the demand for flatfoot recon is artificially generated.
 
It would likely be beneficial for your education and skills if you can pull it off but not guaranteed to benefit you in future job opportunities. Who knows though, if you do fellowship with the right people, those connections could land you in a good spot. I think a lot of good podiatry positions have come about purely from having the right connections or knowing the right people.
Tell that to OFA and other "high powered" fellowships doing PP and not using their skills.

ACFAS won't tell you the truth about the outcomes, the fellows won't tell you the truth because they are disappointed/rationalizing/delusional/"building a brand" on social media

This is SDN, you won't find anyone who will support this.

It's your life. Do whatever you want. But don't make this your only option. Put yourself in position to do what you talk about, but not at the sacrifice of your current training or other job prospects.

See how these next 2 years go. Life happens.

Write your life/professional plans in pencil not pen.
 
It would likely be beneficial for your education and skills if you can pull it off but not guaranteed to benefit you in future job opportunities. Who knows though, if you do fellowship with the right people, those connections could land you in a good spot. I think a lot of good podiatry positions have come about purely from having the right connections or knowing the right people.

Good positions happen because of a combination of good training (foundational training ie residency) good interpersonal skills and hard work. Nobody walks into a good position, they create it and make it happen. @Retrograde_Nail , myself, @DYK343 and a few dozen other people that I know that are all successful have done this. Ok less on the interpersonal skills for Retro. And guess what. None of these were first jobs. You take a little from each experience. My job would not be what it is if I had not had my failures first. You have to be in the arena. This is classic genz or whatever thinking ... everything has to be perfect before you can start. Have to have all the training before can start. Have to have career success and money built up before can start having kids, have to have all the gear before can start over landing.

Don't think, just act.
 
Sorry to be the contrarian in the bunch, but you can do this and it could be extremely valuable for you and your future, depending on your goals. The relationships you'll build would be an academic career jump-starter. I was the first from DMU to do an international rotation (as a 4th year), was with Andrew Boulton at Univ of Manchester in UK. I made lifelong friendships and collaborating partners. It has helped me in other parts of the world as well. You certainly can learn a lot, and teach a lot, internationally. There are many centers around the world which would welcome you.
 
Sorry to be the contrarian in the bunch, but you can do this and it could be extremely valuable for you and your future, depending on your goals. The relationships you'll build would be an academic career jump-starter. I was the first from DMU to do an international rotation (as a 4th year), was with Andrew Boulton at Univ of Manchester in UK. I made lifelong friendships and collaborating partners. It has helped me in other parts of the world as well. You certainly can learn a lot, and teach a lot, internationally. There are many centers around the world which would welcome you.
There you go champ Make your future happen.

I don't know if it was easier back then or it's easier now.
 
Sorry to be the contrarian in the bunch, but you can do this and it could be extremely valuable for you and your future, depending on your goals. The relationships you'll build would be an academic career jump-starter. I was the first from DMU to do an international rotation (as a 4th year), was with Andrew Boulton at Univ of Manchester in UK. I made lifelong friendships and collaborating partners. It has helped me in other parts of the world as well. You certainly can learn a lot, and teach a lot, internationally. There are many centers around the world which would welcome you.

Are you affiliated with any fellowships at the hospital where you’re employed?
 
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I’m intrigued by the logistics.

Generally, the UK (which tends to be the most international friendly system) pays attendings like some US residents. I can’t imagine it’s better for fellows. Canada has some high volume fellowships in my field, but obviously they prefer to keep their own people in system. The rest of the world tends to be very hierarchical and protective of their surgeries, so good luck.

Even if you pick up cool new skills, if the equipment isn’t FDA approved (happens a lot with fancy new European stuff), then sorry when you get home. Or if it’s too expensive for your center, double sorry.

Realistically, unless you’re in academics, there’s a 0% chance you take more than at the very most a month abroad a year if you want a consistent job. If locums suck, you’re boned financially.

It’s a cool thought experiment and you can do you, but sounds impractical as all get out.

*Usual I’m not a pod disclaimer
 
OP - I don't really understand how the logistics of this would work ie. pay, credentialing, language, locations, being a DPM (instead of an MD).

This isn't really the forum for pursuing off the beaten path information. That said - you should try to get @hematosis to reply. They apparently did a European fellowship and ...they have a sour opinion of most American fellowships...

I'm just going to throw to you - you might be surprised that being an attending is a lot more fun than being a trainee. You might even find that you enjoy doing cases on your own and that your skills will grow and translate into things you didn't originally do if you work your way through cases and continue to study / learn / focus on improvement and growth.

Last of all - if you spend 3 years pursuing fellowships rather than building a clientele and practice I feel like you are going to end up like the Clerk in The Canterbury Tales. Anyone?

A clerk from Oxford was with us also,
Who’d turned to getting knowledge, long ago.
As meagre was his horse as is a rake,
Nor he himself too fat, I’ll undertake,
But he looked hollow and went soberly.
Right threadbare was his overcoat, for he
Had got him yet no churchly benefice,
Nor was so worldly as to gain office.
For he would rather have at his bed’s head
Some twenty books, all bound in black and red,
Of Aristotle and his philosophy
Than rich robes, fiddle, or gay psaltery.
Yet, and for all he was philosopher,
He had but little gold within his coffer;
But all that he might borrow from a friend
On books and learning he would swiftly spend,
And then he’d pray right busily for the souls
Of those who gave him wherewithal for schools.
Of study took he utmost care and heed.
Not one word spoke he more than was his need;
And that was said in fullest reverence
And short and quick and full of high good sense.
Pregnant of moral virtue was his speech;
And gladly would he learn and gladly teach.
 
OP - I don't really understand how the logistics of this would work ie. pay, credentialing, language, locations, being a DPM (instead of an MD).

This isn't really the forum for pursuing off the beaten path information. That said - you should try to get @hematosis to reply. They apparently did a European fellowship and ...they have a sour opinion of most American fellowships...

I'm just going to throw to you - you might be surprised that being an attending is a lot more fun than being a trainee. You might even find that you enjoy doing cases on your own and that your skills will grow and translate into things you didn't originally do if you work your way through cases and continue to study / learn / focus on improvement and growth.

Last of all - if you spend 3 years pursuing fellowships rather than building a clientele and practice I feel like you are going to end up like the Clerk in The Canterbury Tales. Anyone?

A clerk from Oxford was with us also,
Who’d turned to getting knowledge, long ago.
As meagre was his horse as is a rake,
Nor he himself too fat, I’ll undertake,
But he looked hollow and went soberly.
Right threadbare was his overcoat, for he
Had got him yet no churchly benefice,
Nor was so worldly as to gain office.
For he would rather have at his bed’s head
Some twenty books, all bound in black and red,
Of Aristotle and his philosophy
Than rich robes, fiddle, or gay psaltery.
Yet, and for all he was philosopher,
He had but little gold within his coffer;
But all that he might borrow from a friend
On books and learning he would swiftly spend,
And then he’d pray right busily for the souls
Of those who gave him wherewithal for schools.
Of study took he utmost care and heed.
Not one word spoke he more than was his need;
And that was said in fullest reverence
And short and quick and full of high good sense.
Pregnant of moral virtue was his speech;
And gladly would he learn and gladly teach.
@Dean’s Chat please read this on the podcast. Better yet, rap it in a backward hat. It’s what the people deserve.
 
A clerk from Oxford was with us also,
Who’d turned to getting knowledge, long ago.
As meagre was his horse as is a rake,
Nor he himself too fat, I’ll undertake,
But he looked hollow and went soberly.
Right threadbare was his overcoat, for he
Had got him yet no churchly benefice,
Nor was so worldly as to gain office.
For he would rather have at his bed’s head
Some twenty books, all bound in black and red,
Of Aristotle and his philosophy
Than rich robes, fiddle, or gay psaltery.
Yet, and for all he was philosopher,
He had but little gold within his coffer;
But all that he might borrow from a friend
On books and learning he would swiftly spend,
And then he’d pray right busily for the souls
Of those who gave him wherewithal for schools.
Of study took he utmost care and heed.
Not one word spoke he more than was his need;
And that was said in fullest reverence
And short and quick and full of high good sense.
Pregnant of moral virtue was his speech;
And gladly would he learn and gladly teach.
Yeah I ain't reading all that.
Here's a modern day interpretation.

POV: You’re on a road trip and this Oxford nerd pulls up with the squad.

Bro’s been grinding academics since medieval times. His horse? Malnourished AF. Like the horse looks like it’s been surviving off vibes. And the dude riding it looks the exact same — skinny, pale, zero gym arc.

Man’s outfit? Negative drip. His coat is so worn out it’s basically vintage depression-core. But that’s because he’s not chasing a church job or trying to get that medieval bag.

Instead of buying cool stuff, bro’s like:
“Yeah I’ll take 20 philosophy books by Aristotle instead.”

So while everyone else is flexing robes, instruments, and rich-person vibes, this dude is just sitting there like:
“Books > everything.”
But here’s the kicker — he’s broke broke. Like medieval college student broke. Every time he borrows money from friends, he immediately dumps it into more books and school stuff.

Then he’s like:
“Thanks for the loan bro, I’ll pray for your soul.” 🙏

Respect honestly.
He barely talks, but when he does it’s not nonsense. No yapping. Just short, smart, big-brain statements.

Every sentence sounds like it could be in a motivational philosophy edit.

At the end of the day, bro’s whole personality is basically:
📚 Learning stuff
📚 Teaching stuff
📚 Being broke but intellectual
 
Yeah I ain't reading all that.
Here's a modern day interpretation.

POV: You’re on a road trip and this Oxford nerd pulls up with the squad.

Bro’s been grinding academics since medieval times. His horse? Malnourished AF. Like the horse looks like it’s been surviving off vibes. And the dude riding it looks the exact same — skinny, pale, zero gym arc.

Man’s outfit? Negative drip. His coat is so worn out it’s basically vintage depression-core. But that’s because he’s not chasing a church job or trying to get that medieval bag.

Instead of buying cool stuff, bro’s like:
“Yeah I’ll take 20 philosophy books by Aristotle instead.”

So while everyone else is flexing robes, instruments, and rich-person vibes, this dude is just sitting there like:
“Books > everything.”
But here’s the kicker — he’s broke broke. Like medieval college student broke. Every time he borrows money from friends, he immediately dumps it into more books and school stuff.

Then he’s like:
“Thanks for the loan bro, I’ll pray for your soul.” 🙏

Respect honestly.
He barely talks, but when he does it’s not nonsense. No yapping. Just short, smart, big-brain statements.

Every sentence sounds like it could be in a motivational philosophy edit.

At the end of the day, bro’s whole personality is basically:
📚 Learning stuff
📚 Teaching stuff
📚 Being broke but intellectual
what did you use? i tried grok and gemini and couldn't get a good AI modernization
 
There are a lot people like the clerk in Canterbury Tales. We’ve all experienced them as undergrads….

To the OP, I say go for it and see where it takes you!

You’ll need to be agile and adjust your plans on the fly.
🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣
 
This is a great read... one of the best threads in awhile!
I hear podiatry fellowships don't add to scope of practice (still a podiatrist), but I hear they may add 3 inches to your height and 2 inches to other stuff.

Don't worry, I considered fellowship briefly back when I was a junior resident (they were in their infancy then, nobody from my program had ever done one). It's normal to consider it for ego or pride or just curiousity... but then I realized I'm not an immortal vampire, my loan interest is compounding, I learned plenty in residency, and you will still have to face the grim podiatry job market nonetheless.
We had decades at my training program, one of the first 3yr ones in podiatry, with no fellowships (just mini-AO or stuff that was basically outside rotations during residency)... typical jobs of PP employ, PP owners, hospital employ, ortho group, etc. For my year, none of the 4 grads applied to fellowships... one retired from regular podiatry already, one will retire soon, one could retire anytime, one will probably work awhile. The next few years after us, a few of the grads started looking at or even doing fellowship: one who wa my junior works at their fellowship group for over a decade now after doing fellowship there, another of the juniors runs an ACFAS fellowship (but never did one themself). The others who just did 3yrs residency have the typical pp, hospital, ortho group jobs that DPMs get, with or without a fellowship. 🙂

But make your own path, OP. Definitely want to PM the Russia bear wrasslin fellowship guy and see how that's going...